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Cancer Screening Guidelines Overview and Processes

The American Cancer Society has issued cancer screening guidelines since 1980. ACS processes and recommendations for the early detection of specific cancer types have evolved with new scientific data, as new screening technologies became available, and as standards for creating guidelines changed. The guidelines published in 1980 were based on a review of the evidence led by Dr. David Eddy, an early pioneer in evidence-based medicine. The introduction of that methodology influenced future guideline updates. The ACS guidelines methodology underwent a review and update in 1997 to formalize a process that included the core stages of guideline development, implementation, and evaluation. The ACS protocol included nine steps to be followed for developing or revising guidelines:

A multidisciplinary Guideline Development Panel to oversee the process

Defined objectives on the cancer type, target groups and how the guidelines will be used

An outcome model which described how the guideline will influence outcomes

A procedure for documenting the rationale for each recommendation

Review of the scientific evidence

Defining the specific types of evidence to be considered in the creating the guideline

Peer review of the draft recommendation by the experts and intended user groups before publication

Evaluation of peer review comments and creation of final guideline

Evaluation and periodic revision of the guideline

The revised process established a more formal method for which screening recommendations for all cancer types should follow.

Although previous approaches resulted in highly credible and useful guidelines, it was recognized that the process could be improved in terms of consistency, transparency, scientific rigor, and communications. In 2011, the American Cancer Society evaluated its own process for creating cancer screening guidelines and made adjustments so its process would be more aligned with the new Institute of Medicine (IOM) standards. A report on the new changes is published in the December 14, 2011 issue of the Journal of the American Medical Association. This new process implemented by the ACS covers 8 principles highlighted by the IOM:

Transparency (explaining how guidelines are created and funded)

Conflicts of interest disclosure for those creating guidelines

Guideline development panel of individuals with appropriate expertise in clinical screening and a patient advocate

Independent systematic review of evidence

Grading strength of each recommendations by explaining the level of confidence in each guideline

Clear articulation of recommendations

External review of the proposed guidelines from outside experts and revising as needed

Timely updating of guidelines when there is new evidence

Currently, the guidelines for the early detection of breast cancer are being updated using the newly revised guideline development process. The breast cancer screening guidelines are being revised by the 12 members of the newly created Guidelines Development Panel, using a systematic review of the evidence conducted by an independent Evidence-based Practice Center. For information on the status and process of the breast cancer screening guideline update, contact us at ACSGuidelines@cancer.org. For more information on ACS current recommendations for the early detection of breast cancer go to our Breast Cancer Screening Guidelines page.

The American Cancer Society provides an annual summary report of its guidelines and recommendations for early cancer detection, data and trends in cancer screening rates, and select issues related to cancer screening. This latest summary describes data on the use of cancer screening from the National Health Interview Survey and issues pertaining to screening coverage under the Patient Protection and Affordable Care Act of 2010. Read the complete version of Cancer Screening in the United States, 2013 in CA: A Cancer Journal for Clinicians.

ACS guidelines for the early detection of cancer in average-risk adults endorse screening for breast cancer, cervical cancer, and colorectal cancer. ACS recommends informed and/or shared decision-making for adults considering prostate cancer screening based on the uncertainty of the balance of benefits and harms, and the new lung cancer screening guidelines also stress shared decision-making. This table provides a summary of ACS recommendations for the early detection of cancer in average-risk, asymptomatic individuals.

In 2011, the American Cancer Society made adjustments to its process for creating cancer screening guidelines and incorporated policies and practices to be more consistent with the new Institute of Medicine standards. Read the complete version of the ACS new process for creating cancer screening guidelines here.

As part of the new process for creating cancer screening guidelines, the ACS Board of Directors appointed a Cancer Screening Guideline Development Group (GDG) to create all ACS cancer screening guidelines. Learn more here.